Indians Buy Organs With Impunity

CHENNAI, India — Police raids here last month that led to the arrests of at least three alleged dealers in human kidneys have thrown a spotlight on lapses by local medical regulators and recharged the global debate over legalized organ sales.

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More than 500 people across the state of Tamil Nadu say they've sold their kidneys to organ brokers, in violation of a ban enacted in 1994. Since then, however, the agency responsible for enforcing the ban has frequently turned a blind eye.

"We do everything in accordance with the letter of the law on paper, but we know that almost all of the documents we see are false," said a member of Tamil Nadu's Transplant Authorization Committee, who spoke to Wired News on condition of anonymity. "It is an open secret. It is either, approve a transplant with forged documents, or a patient is going to die."

Humanitarian arguments excusing black-market organ sales may seem a stretch given the stark danger of exploitation that led to the ban in the first place. Given the failure of India's official system, however, some medical policy experts say some form of legalization may be the best solution.

Under India's 1994 legislation, a state-appointed ethics committee must approve all transplants. The committee must interview all prospective donors before approving each transplant. On average the committee hears 20 requests a week and approves 15. The anonymous committee member said brokers routinely produce forged documents so that the transaction takes on the appearance of legality.

"The major issue as far as India is concerned is getting rid of the brokers. This would mean government regulation or administration of any compensation policy that would be developed," said Transplant News editor Jim Warren, who advocates compensating people at a standard rate and providing state-sponsored health insurance for life.

Such a system, however, might not work if the state is offering less than the global market, says Nancy Scheper-Hughes, a medical anthropology professor at the University of California at Berkeley and founding director of Organs Watch.

"Free health care sounds good on paper, but the problem is that when a country goes legal then it enters into competition with the international market in organ transplant tourism," says Scheper-Hughes. "When the state offers incentives along with a lesser pay scale, but a broker from another country offers slightly more cash without the medical benefits, most people opt for the cash and you run into the same problems you had before legalization."

The Tamil Nadu agency has unofficially sanctioned the illegal organ trade for the past 13 years, the unnamed committee member said. Without illegal organ trade, he says, patients have no hope because in India, organ donation after death is extremely rare. Without incentive, donors are practically nonexistent.

The committee member denies that brokers bribed members of the transplant committee. But local police believe there's more behind the Tamil Nadu organ trade than altruism.

"These brokers are not rich people," said police superintendent Chandrabasu (his only name) of the Crime Branch Central Investigation Department in Chennai. "Out of the (several thousand dollars) they took as their commission from the operation, most of that went to bribes. They would only make about ($300) per transaction in the end."

Flouting the law may have saved lives; but, by allowing brokers to operate with impunity, the Transplant Authorization Committee has allowed poor people to fall victim to organ brokers — the same problem that was rampant before the 1994 organ donation law.

In January, a group of poverty-stricken women living in a tsunami refugee camp 7.5 miles north of Chennai confessed at a public meeting that they sold their kidneys through brokers.

"When I went to the ethics committee, there were four other women sitting next to me who had also been arranged by the broker," said one of the refugees, known as Rani (her only name), in an interview with Wired News.

She said she received only about $900 of the $3,300 she was promised by the broker who arranged her transplant. "We went up one at a time and all (the committee) did was ask me if I was willing to donate my kidney and to sign a paper. It was very quick."

With no viable solution in sight, the Tamil Nadu Transplant Authorization Committee took matters into its own hands, and authorities are scrambling to respond.

The police have three brokers in custody for forgery, according to superintendent Chandrabasu. The director of Medical Services says his division is investigating reports that 52 hospitals may have been involved in illegal transplants.

Tamil Nadu's health minister last week suggested possible ways of strengthening the government ethics committee. He did not return phone calls requesting comment for this story.

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